Mount Carmel Health Partners Clinical Guidelines Diabetes Type II | Page 2

Diagnosis Treatment (continue…)
• HbA1c greater than or equal to 6.5%  If patients with inadequate diabetic controlled and are overweight
consider metabolic Surgery.
- BMI (body mass index) ≥40 kg/m² (BMI ≥37.5 kg/m² in Asian
Americans)
- BMI 35 to 39 kg/m² (BMI 32.5 to 37.4 kg/m² in Asian Americans)
when hyperglycemia is inadequately controlled by lifestyle
measures and optimal medical therapy
OR
• Fasting plasma glucose (FPG) greater than or equal to 126 mg/dL
OR
• 2-hour glucose tolerance test (GTT) greater than or equal to
200 mg/dL
OR
• Two random blood glucose measurements 200mg/dL greater than
200 mg/dL (second test for confirmation)
Evaluation
 Assess risk factors, comorbidities, and identifiable causes of
Risk Factors
hyperglycemia
 Conduct a comprehensive history and physical
 Obtain tests: urinalysis, fasting blood glucose, HbA1c, and renal
Intrinsic
• Age greater than 45
• Ethnic origin/race
• History of hypertension or cardiovascular disease
• Polycystic ovary syndrome
• History of gestational diabetes; baby over 9 lbs.
 Family history of diabetes
 Metabolic syndrome
function panel with GFR, microalbuminuria
 Identify and treat appropriate additional comorbid conditions:
- Hypertension
- Dyslipidemia
- Cardiovascular disease
- Depression
- Disordered eating behaviors
 Assess for metabolic syndrome
Extrinsic
• Excess body weight (BMI greater than 25)
• Pre-diabetes diagnosis
• Diet (saturated fats and refined sugars)
• Physical inactivity
• Heavy alcohol use (more than two drinks/day)
• Tobacco use
Annual Tests
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Treatment
• Appropriate history and physical exam upon diagnosis.
• Monitor HbA1c twice yearly for those meeting treatment goals.
• Monitor HbA1c quarterly for those not meeting treatment goals.
• Treat to desired goal of HbA1c less than 7 percent ¹
• Emphasis on lifestyle modification as the foundation, with medication
added when treatment goal otherwise not met.
• Review self-management of finger-stick blood sugar monitoring.
• Reinforce lifestyle modification (such as diet, exercise, and smoking
cessation).
• Assess compliance to therapy.
• Positive microalbuminuria screen is treated with ACE/ARB
pharmacological therapy.
 American Diabetes Association recommends a blood pressure goal of
140/80.
 Moderate-high intensity statin therapy should be added to lifestyle
therapy, regardless of baseline lipid levels, for patients with diabetes:
- with overt ASCVD
- without ASCVD and have one or more other ASCVD risk factors
(family history of ASCVD, hypertension, smoking, dyslipidemia, or
albuminuria).
 For low-risk patients who are over the age of 40 years, moderate-
intensity statin therapy should be considered in addition to lifestyle
therapy.
 Daily low-dose aspirin therapy is recommended as a primary
prevention in men and women ≥50 years old with at least one ASCV
risk factor and as secondary prevention in all patients with diabetes
and history of ASCVD. If contraindicated, clopidogrel or ticlopidine are
suitable a